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MEDICAL NEWS AND ABSTRACTS FROM OTHER JOURNALS
Reviewed by Wineetha S. Fernando, M.D. POST MENOPAUSAL HORMONE THERAPY INCREASES RISK OF VENOUS THROMBOEMBOLIC DISEASE: THE HEART AND ESTROGEN/PROGESTIN REPLACEMENT STUDY (HERS) 1 It has been unexpectedly found, by analysis of the HERS study of 1998, that coronary heart disease (CHD) events increased in the first year of treatment with Hormone Replacement Therapy (HRT) of post menopausal women with established CHD. A major trial, namely Women's Health Initiative (WHI), has been sponsored by the National Heart, Lung, and Blood Institute to investigate the outcomes in 27,000 women on HRT without CHD. The interim analysis was found to be similar to HERS findings. Currently, the WHI study has demonstrated that, during the first years of HRT, there was a non-significant trend toward increased heart attacks, strokes, and venous thromboembolic events (VTEs). However, after the first two years, there was no difference in the CHD events between those on HRT, and those on a placebo. Currently, there are recommendations against the initiation of HRT for CHD prevention. Further analysis from the data of HERS study also revealed that women assigned to HRT, had a nearly three fold increase in the risk of VTEs. VTE events were more common in women with lower extremity fracture, those who developed cancer, or those who were within 90 days of an inpatient surgical intervention. Women who had their last menstrual period at age older than 52 years, also were found to be at a higher risk of developing VTE, which was probably due to their high level of endogenous estrogen production. The risk factors for CHD which have been identified previously, such as smoking, age, obesity, and hypertension, were not demonstrated in this study, after adjustments for the above factors were made. Currently, indications for HRT are diminishing according to the authors of this article. Further analysis of data from the HERS study also has revealed that women with a higher baseline lipoprotein A level had a lesser incidence of CHD events, and vice versa. The Estrogen Replacement and Atherosclerosis (ERA) trial has demonstrated that HRT did not worsen or improve plaque buildup in post menopausal women with pre-existing CHD. The author's comment is that it will be interesting to see, if the final outcome of the WHI study would agree with the increased risk of VTE's in post menopausal women on HRT, as was found by the HERS study. HRT may ultimately be limited to a smaller group of women as more information becomes available on the adverse effects of such therapy. * * * * About the Reviewer This review represents the opinion of the Reviewer and does not reflect the official policy of the American Academy of General Physicians nor the institutions with which the Reviewer is affiliated. References |
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